Provider Demographics
NPI:1437643301
Name:1BY GRACE TEFRA SERVICES, LLC
Entity Type:Organization
Organization Name:1BY GRACE TEFRA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANUL DUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-854-9214
Mailing Address - Street 1:6644 CIMARRON CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3945
Mailing Address - Country:US
Mailing Address - Phone:907-854-9214
Mailing Address - Fax:888-722-5542
Practice Address - Street 1:6644 CIMARRON CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3945
Practice Address - Country:US
Practice Address - Phone:907-854-9214
Practice Address - Fax:888-722-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management